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Why Not All Self-Harm Is the Same

A new book argues that you can't throw people pulling their hair out and people cutting themselves into the same category.

(Top image: A screenshot from 'The Virgin Suicides'. Image: American Zoetrope / Paramount Classics)

There are as many meanings to self-harm as there are self-harmers, Sarah Chaney explains in her new history of the phenomenon,  Psyche on the Skin. Reading the archives from the Bethlem asylum in London, Chaney noticed that staff would record whether new patients were "suicidal or otherwise inclined to self-injury".

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To Chaney this phrase seemed strangely familiar, at odds with her assumption that self-harm was a contemporary phenomenon. Indeed, the words from the Bethlem archives were remarkably similar to those used in the American Psychiatric Association's manual(usually called the DSM), which describes "non-suicidal self-injury" as a distinct condition.

In the book, Chaney sets out to understand the history of self-harm. As she explains, deliberately hurting oneself has a long history – for example, think of self-flagellation for religious reasons – but the category of "self-harm" as a distinct behaviour that is related to mental distress is an invention of the 19th century. According to Bethlem patient records from the 1850s, Sophia W had "a disposition to injure herself by knocking her head against the wall and biting herself", while Henry M had sores all over his head, face and legs from "picking and scratching himself".

Ever since these "perverted impulses" were identified, some psychiatrists have tried to explain them in universal terms. The American psychoanalyst Karl Menninger argued in Man Against Himself (1938) that self-harm was an unconscious redirection of suicidal impulses, and thus (at least according to some of his followers) proof of the Freudian model of human psychology.

But Chaney argues that the idea of an overarching category of self-harm doesn't really work. "Since the late Victorian period almost every medical category of self-harm [has assumed] that there is some kind of equivalence between behaviours and that there is some kind of universal meaning," she told me, "but why should someone trying to cut off their own hand be somehow the same as someone pulling out their hair?"

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In contemporary British society, self-harm is most often portrayed as an individualised, private behaviour that expresses the inner turmoil of the self-harmer in some way, whereas in other eras it tended to be understood in terms of the environment, or the role of the family.

Self-harm should be understood as emerging from a cultural context, not simply from a solitary mind. Researchers like Armando Favazza, who came to psychiatry after first studying anthropology, believes that some forms of self-injury represent "an attempt at self-healing". Globally, he pointed out, culturally-sanctioned forms of self-mutilation are widespread.

Even Menninger was deeply influenced by the circumstances of his time. "His view of self-mutilation and suicidal behaviour as evidence of the Freudian death instinct was very much bound up in his view of what was happening in the world. As he put it [in some of his other writing], 'What suicide and self-harm is for the individual, so war is for the nation.' He was using these cases to prove a self destructive path for humanity, not just the individual."

For that reason, Chaney is convinced that prevailing ideas around self-harm actually say a lot more about the people who express them, or the culture that gives birth to them, than they do about the behaviour itself. In contemporary British society, self-harm is most often portrayed as an individualised, private behaviour that expresses the inner turmoil of the self-harmer in some way, whereas in other eras it tended to be understood in terms of the environment, or the role of the family. What Chaney suggests therefore is that the focus on private personal turmoil "reflects an increasingly individualised understanding of how human beings function".

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When we spoke, Chaney was cautious on the subject of self-harm and its prevalence in Britain today, but said that it has probably increased in the last two decades. It's very difficult to say so with any certainty, though. NHS statistics are inconsistent, sometimes based on self-reporting and other times based on access to emergency services – which obviously favours certain, more severe, kinds of harm. There's little reason to believe that cutting yourself (or burning yourself, for that matter) causes the same level of harm as a near-fatal overdose or comes from the same place psychologically.

One thing we can be sure of is that self-harm is more visible than it has ever been. As with so many things, this can largely be attributed to the internet. "The types of quite public conversations that people might have on a forum are not the kinds of public conversations that you could view before that. If people were having them with friends they weren't recorded," Chaney explains.

Though events like the disappearance of (famous self-harmer) Manic Street Preachers' guitarist Richey James triggered an outpouring of emotion in the letters pages of the music press, "it was the  NMEand  Melody Makerthat decided what to print and when". Now, self-publication gives anybody who wants it the power to create their own narrative. While in itself this won't necessarily reduce levels of self-injury, it might help some people find their way out of an impasse which has been clouded by the fog of stereotype and misunderstanding.

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If you are affected by any of the issues in this piece, help is available from Selfharm UK or the Samaritans

UPDATE 27/03/17: An earlier version of this article contained an introduction describing a method of self-harm in detail. This section has been removed in keeping with NUJ editorial guidelines for reporting on mental health, self-harm and death by suicide.

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How Self-Harm Became a Teenage Issue, and What Can Be Done About It

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